WORKSHOP/CLASSES REGISTRATION FORM
Seeds for Change Wellness
105 Oak Drive Sellersville, PA 18960
email: seedsforchange@comcast.net
website: www.seedsforchangewellness.com
Phone:
(Susan Anderson) 267-377-0088
(Scott Anderson) 267-218-1027
Workshop/ Class Registration
PLEASE TYPE OR PRINT CLEARLY:
Name: ______________________________________ Date: _____________________
Address:
____________________________________ ______________________ ____________
(Street) (Town) (Zip Code)
Telephone: ___________________________ email address: _______________________
Registration for:
Workshop/Class Title: _____________________________________________________
Workshop Cost: _______________
Date: ____________________________________ Time: ________________________
Payment Options:
_____ Check enclosed (Please Make Check Payable to: Seeds for Change)
_____ Payment made through Seeds for Change Wellness Online Store
Mail Completed Registration to the Above Address
Registration is Confirmed Upon Receipt of Payment